Perioperative strategies to reduce risk of myocardial injury after non-cardiac surgery (MINS): A narrative review.

Bello, Corina; Rössler, Julian; Shehata, Peter; Smilowitz, Nathaniel R; Ruetzler, Kurt (2023). Perioperative strategies to reduce risk of myocardial injury after non-cardiac surgery (MINS): A narrative review. Journal of clinical anesthesia, 87, p. 111106. Elsevier 10.1016/j.jclinane.2023.111106

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Myocardial injury is a frequent complication of surgical patients after having non-cardiac surgery that is strongly associated with perioperative mortality. While intraoperative anesthesia-related deaths are exceedingly rare, about 1% of patients undergoing non-cardiac surgery die within the first 30 postoperative days. Given the number of surgeries performed annually, death following surgery is the second leading cause of death in the United States. Myocardial injury after non-cardiac surgery (MINS) is defined as an elevation in troponin concentrations within 30 days postoperatively. Although typically asymptomatic, patients with MINS suffer myocardial damage and have a 10% risk of death within 30 days after surgery and excess risks of mortality that persist during the first postoperative year. Many factors for the development of MINS are non-modifiable, such as preexistent coronary artery disease. Preventive measures, systematic approaches to surveillance and treatment standards are still lacking, however many factors are modifiable and should be considered in clinical practice: the importance of hemodynamic control, adequate oxygen supply, metabolic homeostasis, the use of perioperative medications such as statins, anti-thrombotic agents, beta-blockers, or anti-inflammatory agents, as well as some evidence regarding the choice of sedative and analgesic for anesthesia are discussed. Also, as age and complexity in comorbidities of the surgical patient population increase, there is an urgent need to identify patients at risk for MINS and develop prevention and treatment strategies. In this review, we provide an overview of current screening standards and promising preventive options in the perioperative setting and address knowledge gaps requiring further investigation.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy > Partial clinic Insel
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Bello, Corina Manuela

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-4529

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

20 Mar 2023 10:40

Last Modified:

30 Apr 2023 00:17

Publisher DOI:

10.1016/j.jclinane.2023.111106

PubMed ID:

36931053

Uncontrolled Keywords:

Cardiac complications after surgery Mortality after surgery Myocardial injury Postoperative complications

BORIS DOI:

10.48350/180310

URI:

https://boris.unibe.ch/id/eprint/180310

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